Hong Kong is facing the challenge of fast population aging. One of the natural parts of many disease process is eating problem with poor appetite and swallowing difficulty. Unless there is a valid advance directive (AD) or advance care planning (ACP) opted not for enteral feeding, family members and healthcare professionals often feel obliged to start tube feeding. This explains partly the popularity of nasogastric (NG) tube feeding in older people. As yet, evidence has shown that NG feeding does not offer extra benefits to older patients. NG tube or gastrostomy feeding are not effective in preventing aspiration pneumonia. Enteral feeding fails to improve serum albumin, body weight and lean muscle mass. The use of feeding tube brings patient discomfort, increased application of physical restraints and possibility of pressure sore development. Older people in residential care homes for the elderly (RCHE) with feeding tubes are repeatedly transferred to emergency because of tube complications. Evidence is also lacking for survival benefits in older people with tube feeding.
Careful hand feeding (CHF) or comfort feeding has been advocated as an alternative for older people with advanced dementia and eating problems. Hospital Authority Guidelines on Life-Sustaining Treatment in the Terminally ill was updated in 2016, providing a clear picture of CHF from the ethical perspective. Yet, there are many practical barriers in carrying out CHF in hospitals including manpower issues and the urge to discharge patients quickly due to high volume of patients. The present talk will introduce the CHF program in Fung Yiu King Hospital (FYKH), a geriatric step-down hospital in Hong Kong West Cluster (HKWC). The results of the outcome study on the CHF program conducted in FYKH will be shared. In addition, the present talk will review international literature on CHF, including a recently published local control study comparing NG tube feeding and CHF. Way forward for CHF in local hospitals will be discussed.
